Release of Information

Blank Release of Information (ROI) Forms For print or PDF download
Waterville	Winthrop
11 Caldwell Rd., Augusta	Skowhegan
66 Stone St., Augusta	Farmington

	Use the dropdown list to choose which Status of releases you would like to view. Check the Default box to save your preference.
	Generate a new release.
	Generate a General Payor release.
	Generate a new release in PDF form. This will pre-fill client information at the top but will be otherwise blank for you to print and manually complete.
	Delete the selected release.
	View the release in PDF form.
	To renew the release.
	Allow the selected release to expire without generating a Neo alert to renew it.
	Add a comment for this release or read previously stored comments.
	Release was printed onto paper and signed by client and then scanned into their chart. Use this button to view the original scanned copy.
	Select this release to view/edit (not available on releases that have already been signed, or have expired)

Release Status Meanings
	Active	Release has been signed, and it is still within the approved time frame.
	Inactive	Release not active.
	Expired	Release had been signed by client; however, time limit has been surpassed.
	Revoked	Release was once active, but client withdrew consent for release prior to the original release's expiration date.
	Invalid	Release has been designated as not valid.
	Declined	Client has not to sign this release.
	Waiting For Client Signature	Release has been sent to the Client Portal for signature.
	Waiting For Staff Approval	Release has been signed by client and has been designated to require staff review/approval before it will be categorized as active. Review/approval is done through the Document Delivery screen.

KBH University